Individual
KENDALL A BOLINE FENSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
1101 S 1ST ST, WILLMAR, MN 56201
(320) 235-0515
Mailing address
1101 S 1ST ST, WILLMAR, MN 56201
(320) 235-0515
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3122
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3C400B0
BCBS PROV ID
MN
05
—
900022400
—
MN
Enumeration date
07/16/2007
Last updated
06/19/2015
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